The Trump administration is planning to set up procedures for allowing States to convert the Medicaid funding they receive from the Federal government from matching funds to block grants.

The new procedures would represent a large change.

Medicaid funding is open-ended, meaning the federal government matches state spending. If that funding is converted to a block grant, a state could get a limited, lump sum of federal money instead.

There are two key differences here. One is that the funding would go from strings-attached matches to no-strings block grants. The other is that the decision to go to block grants would be each requesting State’s, resulting in less Federal control over that State’s internal affairs.

Of course, this has vested interests twisting in their knickers.

Consumer groups and [Progressive-]Democrats say that limitation means thousands of people could lose Medicaid coverage or be unable to enroll if states’ costs rise or enrollment swells.

This is cynical and disingenuous. Whether a State’s citizens lose or can’t get access to their own State’s Medicaid is a matter strictly for, and wholly under the control of, the politicians and bureaucrats in that State’s government and the citizens who elect those politicians—who are the bureaucrats’ direct bosses.

At bottom, there is nothing at all preventing a State from reallocating its own spending to cover those costs or enrollments. Or of limiting access to ensure the truly needy can get the aid, limits that too often are blocked by those Federal strings.